Pleural Pathology 20/04/14
Katherine Syred
What History?
• Needs to correlate to a diffuse pleural abnormality to consider meso as diagnsosis
• Asbestos history probably doesn't help in reality
Pleural diagnosis
Diffuse pleural
abnormality
MDT discussion
Morphology and Immuno
PM Diffuse abnormality
28194/14
BerEP4
Calretinin
CK 5
EMA
WT 1
MOC31 – (focal!)
Diagnosis
• Monophasic epithelioid Mesothelioma
19227/14
TTF-1
CEA
CK5 superficial +
MOC 31
CEA
D240
MNF diffusely +
EMA
WT1 – nuclear positive
Diagnosis
• Biphasic Malignant Mesothelioma
Immuno Panel, Epithelioid Meso
Epithelial/ glandular
Mesothelial Cytokeratins
CEA Calretinin Ck 5 (meso)
MOC 31 Thrombomodulin
Moc31 D240
BerEP4 WT-1 nuclear
TTF-1
• Use immuno panel according to markers validated in your lab. Use 6 markers or +.
• If CEA positive, probably carcinoma.
• MOC31/ BER EP4 focal often seen in Meso.
Sarcomatoid Mesothelioma
• Add Pan cytokeratin Ae1/3, MNF116
Differential Diagnosis Epithelioid Meso
• Metastatic adenocarcinoma (lung/ other)
• Epithelioid haemangioendothelioma/ Angiosarcoma (can have focal cytoketin +, beware vessels stain for thrombomodulin)
What are the differential Diagnoses? Sarcomatoid pleural Neoplasm
• Sarcomatoid Mesotheloima
• Sarcomatoid bronchogenic carcinoma
• Primary pleural sarcoma (rare)
-Synovial sarcoma, Cd99
-Solitary Fibrous tumour, Cd34,
Sarcomatoid Mesothelioma
Sarcomatoid Meso
Desmoplastic Mesothelioma
Synovial Sarcoma of pleura
Angiosarcoma, Cd31, Cd34
MESO biphasic
Calretinin
CEA
WT1 +both areas